DESCRIPTION: In Rakai District, Uganda, fishing communities on Lake Victoria have extremely high HIV prevalence (35-48%) and incidence (~3.9/100 person-years). Such geographic hotspots fuel HIV epidemics, yet have not been the focus of combination HIV prevention (CHP) and demand generation efforts. We propose a sequential mixed methods study to understand the factors shaping HIV risk and service utilization in three Rakai fishing communities and iteratively develop an integrated, tailored CHP and demand generation program through data triangulation and community feedback. This study will be conducted through the Rakai Health Sciences Program (RHSP), which oversees PEPFAR-funded HIV services in the district and conducts a longitudinal cohort study among all residents aged 15-49 in 54 communities, including the three fishing communities. Aim 1 will qualitatively assess the social, occupational, and gendered context shaping HIV risk including nature of sexual partnerships and barriers to uptake of CHP services, in 3 fishing communities. Aim 2 will use findings from Aim 1 to develop additional survey modules for fishing communities (N~2500), as part of the annual cohort survey, to quantitatively assess the prevalence and distributions of key factors associated with (1) HIV prevalence, and (2) utilization of various HIV prevention and care services. Aim 3 will develop a tailored, integrated CHP and demand generation program for fishing communities based on findings from Aims 1 and 2, along with triangulation with existing data sources (longitudinal surveillance data, geospatial analytics, and clinical service delivery statistics), and a second round of qualitative research for community buy-in and feedback on the proposed interventions. A final community-supported and tailored CHP approach will then be developed to be implemented and evaluated in future studies. This will inform CHP and demand generation programs in other hotspot fishing communities in East Africa and beyond.